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array:24 [ "pii" => "S2387020616301292" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.04.004" "estado" => "S300" "fechaPublicacion" => "2016-01-15" "aid" => "3334" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2016;146:49-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315003231" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.04.030" "estado" => "S300" "fechaPublicacion" => "2016-01-15" "aid" => "3334" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2016;146:49-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 40 "formatos" => array:2 [ "HTML" => 20 "PDF" => 20 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Estudio de factores pronósticos y de la prevalencia del síndrome postrombótico en España en pacientes con trombosis venosa profunda" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "54" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Study of prognostic factors and prevalence of post-thrombotic syndrome in patients with deep vein thrombosis in Spain" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1493 "Ancho" => 2417 "Tamanyo" => 213716 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Factores de riesgo de TVP.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Josep Ordi, Luis Salmerón, Fernando Acosta, Isabel Camacho, Núria Marín" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Josep" "apellidos" => "Ordi" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Salmerón" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Acosta" ] 3 => array:2 [ "nombre" => "Isabel" "apellidos" => "Camacho" ] 4 => array:2 [ "nombre" => "Núria" "apellidos" => "Marín" ] 5 => array:1 [ "colaborador" => "en representación de los investigadores del estudio ESPOT-TVP" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616301292" "doi" => "10.1016/j.medcle.2015.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616301292?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315003231?idApp=UINPBA00004N" "url" => "/00257753/0000014600000002/v1_201601130113/S0025775315003231/v1_201601130113/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616300560" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.05.048" "estado" => "S300" "fechaPublicacion" => "2016-01-15" "aid" => "3359" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2016;146:55-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Early intensive treatment improves outcomes in patients with glomerular hyperfiltration and type 2 diabetes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El tratamiento intensivo precoz mejora los resultados en pacientes con hiperfiltración glomerular y diabetes tipo 2" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1633 "Ancho" => 1606 "Tamanyo" => 157593 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan•Meier survival analysis of the risk of doubling creatinine according to baseline isotopic GFR and UAE over a mean of 17 years of follow-up. The only difference was observed between baseline isotopic GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>120<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and baseline UAE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and the other three groups (LogRank 0.004). Isotopic GFR, isotopic glomerular filtration rate; UAE, urinary albumin excretion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria-Isabel Troya, Josep Bonet, Isabel Salinas, Ferran Torres, Jordi Bonal, Anna Sanmartí, Ramón Romero" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Maria-Isabel" "apellidos" => "Troya" ] 1 => array:2 [ "nombre" => "Josep" "apellidos" => "Bonet" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Salinas" ] 3 => array:2 [ "nombre" => "Ferran" "apellidos" => "Torres" ] 4 => array:2 [ "nombre" => "Jordi" "apellidos" => "Bonal" ] 5 => array:2 [ "nombre" => "Anna" "apellidos" => "Sanmartí" ] 6 => array:2 [ "nombre" => "Ramón" "apellidos" => "Romero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775315004017" "doi" => "10.1016/j.medcli.2015.05.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315004017?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616300560?idApp=UINPBA00004N" "url" => "/23870206/0000014600000002/v1_201605240650/S2387020616300560/v1_201605240650/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2387020616301425" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.07.003" "estado" => "S300" "fechaPublicacion" => "2016-01-15" "aid" => "3372" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2016;146:65-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Post-thrombotic syndrome: A pending issue" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome postrombótico: una asignatura pendiente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Gabriel Botella" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Gabriel Botella" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315004522" "doi" => "10.1016/j.medcli.2015.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315004522?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616301425?idApp=UINPBA00004N" "url" => "/23870206/0000014600000002/v1_201605240650/S2387020616301425/v1_201605240650/en/main.assets" ] ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Study of prognostic factors and prevalence of post-thrombotic syndrome in patients with deep vein thrombosis in Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Josep Ordi, Luis Salmerón, Fernando Acosta, Isabel Camacho, Núria Marín" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Josep" "apellidos" => "Ordi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Luis" "apellidos" => "Salmerón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Fernando" "apellidos" => "Acosta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "Isabel" "apellidos" => "Camacho" "email" => array:1 [ 0 => "Isabel.camacho@alphabioresearch.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 4 => array:3 [ "nombre" => "Núria" "apellidos" => "Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:2 [ "colaborador" => "on behalf of the study investigators ESPOT-TVP" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario San Cecilio, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Biometría, Alpha Bioresearch, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento Médico, Bayer Hispania S. L., Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de factores pronósticos y de la prevalencia del síndrome postrombótico en España en pacientes con trombosis venosa profunda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1489 "Ancho" => 2475 "Tamanyo" => 201279 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DVT risk factors.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The post-thrombotic syndrome (PTS) is one of the most frequent complications of deep vein thrombosis (DVT), with a high impact on the quality of life of patients who develop it.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> However, the actual prevalence of the disease is unknown and there is great controversy as to the potential factors that might predispose to the development of PTS after DVT.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Data released on incidence collect great variability, ranging from 30 to 50% of people who have developed a DVT, and 5–10% of them will develop a severe form of SPT, which will involve important socioeconomic and clinical consequences, and poor quality of life. This wide range of outcomes has been associated mainly to differences in both the design and monitoring of studies conducted as well as the diagnostic criteria used, making it difficult to compare these results. SPT is diagnosed from clinical data, based on signs and symptoms in patients who have previously developed a DVT.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> In this regard, the Subcommittee on Control of Anticoagulation of the Scientific Committee for Standardization of the International Society of Thrombosis and Haemostasis recommended, as a measure to standardize the determination of PTS in clinical research, the use of Villalta scale as a tool in order to diagnose and determine the PTS severity objectively.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Although not routinely used currently in clinical practice, the study of its psychometric properties has shown its validity in the determinations on the PTS.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The PTS is believed to occur as a result of venous hypertension, a reduction in venous return and calf muscle perfusion, impaired microcirculation and increased tissue permeability, which explains most symptoms and signs of PTS.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> The standard anticoagulant treatment for DVT prevents from spreading and thrombus embolization, but it does not destroy it, and in many cases it only reduces its size partially.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Unlike DVT, very little is known about the factors that increase the risk of developing a PTS, as the only one identified so far is the recurrent DVT. Some predisposing factors include age, obesity, previous history of ipsilateral DVT, the femoral-iliac site of DVT, failure to recover from initial symptoms of DVT and failure in oral anticoagulant therapy. The lack of recanalization of venous thrombus within the first 6 months of DVT appears to be an important predictor of PTS, while the role of venous reflux is controversial. PTS treatment is symptomatic, never curative and therefore frustrating. The latest results released have shown that only an early use of compression stockings seems to prevent, improve or stabilize the PTS. Fibrinolytic treatment in the acute phase of DVT has been inconclusive, as well as surgery or thromboprophylaxis of DVT in patients at risk, or prevention of ipsilateral DVT. Similarly, clinical evidence is not available to support systemic thrombolysis for preventing PTS, and no sufficient studies are available to assess the effectiveness of local thrombosis by placing a catheter intended to reduce the PTS.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2,7,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, the aim of our study was to determine the prevalence of PTS in Spanish hospitals through Villalta scale and identify the presence of risk factors predisposing to the development of PTS in people with previous DVT.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methodology</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Transversal observational, retrospective, multicenter study, conducted in 28 hospitals located throughout the Spanish geography. Patients included had to be of legal age, be provided with documented diagnosis of DVT from March 2010 to March 2011, and providing written consent to participate. Sociodemographic and clinical variables were collected, together with data on DVT from medical records, retrospectively from the time of inclusion, including: history prior to the event, date of diagnosis, tests performed, treatments and complications or previous episodes at the time of inclusion.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee for Clinical Research of Hospital Vall d’Hebron in Barcelona, and all patients signed the informed consent before being enrolled in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sample size</span><p id="par0040" class="elsevierStylePara elsevierViewall">Due to the limited literature on potential factors that might contribute to the emergence of PTS and the wide range of its prevalence of occurrence, for sample calculation of this study take the worst situation, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">q</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>50%.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Considering 4.4% accuracy and a 95% confidence interval, the sample size was 496 patients. The estimation of patients lost was around 5%. Therefore, the total number of patients to be included in our study was 520.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Diagnosis of post-thrombotic syndrome</span><p id="par0050" class="elsevierStylePara elsevierViewall">At the time of inclusion the patients underwent physical examination and the presence of PTS was evaluated. Villalta scale was used to define the presence of PTS,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> which records a combination of signs and symptoms. The total score corresponding to adding the 5 symptoms and 6 signs together states that a patient has PTS if the result obtained in the total score is over 4 points or presents a venous ulcer. In accordance with this criterion, the patients included were distributed in patients with presence of PTS (Villalta score<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4) and patients with absence of PTS (Villalta score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Assessment of quality of life</span><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were provided with the EuroQol-5D scale of quality of life, which explores five dimensions of quality of life related to health (descriptive system), and a visual analogue scale (VAS) from 0 to 100<span class="elsevierStyleHsp" style=""></span>mm, for self-assessment by the patient's perception of their overall health. The 5 dimensions studied were: mobility, self-care, daily life activities, pain/discomfort and anxiety/depression. Quality of life can vary from 5 points (satisfactory state of health) to 15 (maximum impairment).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">All variables of the population that met the selection criteria and did not violate the protocol were analyzed. We performed a descriptive analysis of all variables collected (demographics, medical history, etc.) for all patients who make up the valid sample, on the whole group and each of the patient groups established (presence and absence of PTS).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Quantitative variables were described by the mean, median, standard deviation, minimum, maximum and total number of patients with available data. The qualitative variables, through their distribution of absolute and relative frequencies. The primary variable evaluated was the prevalence of PTS expressed by the percentage of patients who had more than 4 points or presence of venous ulcer and 95% confidence interval obtained through the Villalta scale completed by themselves in the study visit.</p><p id="par0070" class="elsevierStylePara elsevierViewall">For secondary endpoints, we will identify the potential factors that might be associated or contribute with emergence of PTS in patients with previous DVT. For each factor (risk factors, DVT treatment, etc.) the frequency of occurrence of PTS has been determined. For qualitative variables, univariate analysis have been performed using the chi-square or Fisher's exact test, depending on the characteristics of the variable, and for quantitative variables, the <span class="elsevierStyleItalic">t</span>-Student test or the Mann–Whitney <span class="elsevierStyleItalic">U</span> test. For each significant risk factor it has been calculated the risk of developing a PTS in patients exposed to this factor versus patients not exposed to it, measured through the odds ratio and 95% confidence interval. The significance level we worked with was 0.05. All statistical analysis were performed with SAS 9.2. software</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Population characteristics</span><p id="par0075" class="elsevierStylePara elsevierViewall">511 patients were enrolled in the analysis from June 2012 to April 2013 in 28 hospitals, 7 of those patients were excluded for not meeting the protocol criteria. Of the 504 patients analyzed, 267 (53%) had PTS, and 237 (47%) did not. 50% of <span class="elsevierStyleItalic">patients with PTS</span> were men with a mean age of 63<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15 years, and 61.6% of <span class="elsevierStyleItalic">patients without PTS</span> were men with a mean age of 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 years, with significant differences, both in sex (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0090; chi-square test) and age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0018; Mann–Whitney <span class="elsevierStyleItalic">U</span> test) between the two populations. The characteristics of the overall group and of both populations are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Comparing both populations showed significant differences for the emergence of cardiovascular risk factors. The history of DVT clinical symptoms with pain (81.3 vs 73.4%) and cyanosis (16.9 vs 8.9%) were significantly higher in patients who developed PTS compared to patients who did not.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Most DVTs were diagnosed with doppler ultrasound (97.8%), and no significant differences were reported in the location of DVTs between the two study populations.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The distribution of patients according to treatment received for DVT was similar in both study populations. 68.9% of the overall study population received treatment with low molecular weight heparin (LMWH) in combination with oral anticoagulation (OAC), 23.6% only LMWH, and 4.2%, only ACO. Among the LMWH, enoxaparin was the most scheduled; no differences were reported in the duration of anticoagulant therapy, which was 2 weeks for both groups, regardless of the LMWH used. Regarding oral anticoagulants, acenocoumarol was the most used, with a median treatment duration of 212 days.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">PTS prevalence</span><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of PTS was 53% (95% CI 48.6–57.3), and distribution was 56.2% mild, 20.6% moderate and 23.2% severe according to the Villalta scale (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The average score of the Villalta scale was 1.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 for controls and 10.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.8 for patients with PTS, and the mean time to PTS emergence (Villalta questionnaire) from the DVT was 26.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1 months.</p><p id="par0100" class="elsevierStylePara elsevierViewall">69.3% of the total sample with data available (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>371) used elastic stockings. In patients without and with PTS these percentages were 73.3 and 67.1%, respectively. No significant differences were reported between both groups in the use of elastic stockings.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Risk factors</span><p id="par0105" class="elsevierStylePara elsevierViewall">The number of DVT risk factors was significantly higher in PTS population than in the population with no PTS (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0165; chi-square test). 46.1% of PTS patients had a single risk factor compared to 55.7% in patients without PTS. However, about 52.4% of PTS patients and 43.9% of patients without PTS had more than one risk factor.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Idiopathic disease, smoking, immobilization, obesity, postsurgery and neoplasm were the most frequent risk factors in both populations (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Periods of immobilization (OR 2.27, 95% CI 1.51–3.40), hormone therapy (OR 4.57, 95% CI 0.99–21.08) and obesity (OR 2.16, 95% CI 1.41–3.30) appear as factors strongly associated with the risk of developing PTS after DVT.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Quality of life</span><p id="par0115" class="elsevierStylePara elsevierViewall">The average overall EuroQol-5D score was significantly higher in the PTS population compared to the patient population with no PTS (7.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1 vs 5.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; chi-square test).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Analysis of the 5 dimensions of the EuroQol-5D scale in both groups of patients showed differences statistically significant between them, evidencing the presence of problems. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the percentage of patients with problems in each group (some/many) in each of the five dimensions of the scale.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Combining the values of every EuroQol-5D dimension shows that the best situation was present in 173 patients, 80.3% with no PTS (139 patients) and 19.7% with PTS (34 patients). In the group of PTS patients, 58.7% had the abovementioned health compared to 12.7% of those with PTS, who showed worse overall health.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally, the average VAS value in the perception of the patients about their health also showed differences statistically significant between groups of absence and presence of PTS (77.7 vs 62.4; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; Mann–Whitney <span class="elsevierStyleItalic">U</span> test), indicating a worse health state in PTS patients compared to patients without PTS.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">PTS is one of the most frequent complications of DVT, with a high impact on the quality of life of the patient and it causes a high economic cost for society.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> However, despite this, today the actual incidence of disease and risk factors that favor its development is still uncertain.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our work is one of the few recent multicenter studies that have determined the PTS prevalence in Spain. The results indicate that 53% of patients with a DVT developed a PTS sometime within 2 years following the thrombotic episode, and in 12% of patients this was serious. These values are higher compared to those published by Prandoni et al.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>, who found an incidence of 17.3 and 22.8% in the first and second year of follow-up, respectively, and 29% at 8 years, but in line with the other Spanish studies reporting incidences of 65% after 5 years of DVT and 54% after 12 months.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> Despite these variations, and the existence of some studies with results showing a period ranging from 5 to 8 years from acute DVT until PTS manifestation, most studies indicate the presence of PTS between the first and second year after the thrombotic episode.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2,12,13</span></a> These data are consistent with those observed in our study population. The average time between the episode of DVT and diagnosis of PTS was 26 months. However, given the design of our study, it is possible that in many cases there were manifestations of PTS before Villalta scale and they were not previously diagnosed. Therefore, this data might be confusing. On the other hand, the intensity and severity of signs and symptoms emerging in a PTS patient can fluctuate over time after DVT, although these authors evidenced the severity one month after DVT as long-term PTS prognosis.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Factors that may lead to the development of a PTS are not well identified, and there is some controversy regarding their prognostic validity.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> In recent years, recurrent ipsilateral DVT<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14,16,17</span></a> and DVT location have been identified as the risk factors most significant in the development of a PTS.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14,18,19</span></a> However, in our study we could not demonstrate any association between the location of DVT and development of PTS, and no differences were reported between the group that developed PTS compared to the group that did not. By contrast, and like other authors<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">7,15,20</span></a> we found that some of the DVT risk factors in PTS patients, such as obesity and immobilization, showed two times higher risk of developing PTS, and hormonal treatment, a risk over 4 times. Moreover, the number of DVT risk factors was significantly higher in PTS patients.</p><p id="par0150" class="elsevierStylePara elsevierViewall">On the other hand, although some authors show a relationship between the type and intensity of oral anticoagulant therapy after thrombotic episode<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> and a higher predisposition to develop a PTS, in our population we have not detected significant differences in oral anticoagulant therapy received by PTS patients compared to the therapy received by no PTS patients, in line with the results of other studies.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18,22</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In recent years, many authors have supported the use of elastic stockings in DVT patients as a PTS preventive measure, and its use is associated with a decreased incidence of PTS.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8,11,23</span></a> However, recently the results of SOX prospective randomized study have shown the preventive effect of using these stockings. These authors, after 2 years of follow-up, did not detect any difference in the incidence of PTS among patients using elastic stockings and those using placebo instead.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> In our study, no significant differences were reported in the use elastic stockings among patients who developed PTS and those who did not.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The main limitations of this study are on the one hand, resulting from its retrospective design, which usually involves lack of homogeneity in the data collected and the time when these were obtained, compared to their prospective collection. In addition, as indicated in this section, the use of the Villalta scale transversely in time can bring some confusion in the time between the episode of DVT and emergence of PTS. However, the method used in identifying PTS patients collects objective criteria and is considered valid for the development of research studies. Furthermore, the parallel study of a control cohort not developing PTS, allows to compare and highlight the differences between the two groups, since all the data were collected under the same conditions.</p><p id="par0165" class="elsevierStylePara elsevierViewall">It is known the impact of this disease on the health of patients who suffer from it.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a> Through the EuroQoL-5D questionnaire on quality of life, in our study, we found health condition was significantly worse in PTS patients compared to controls, highlighting problems in all dimensions: mobility, self-care, daily life activities, pain/discomfort and anxiety/depression, which makes the quality of life of these patients to be seriously affected. Similar results were shown by Fajardo et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a>, who through a specific questionnaire to assess the quality of life in patients with chronic venous insufficiency prove the correlation between the severity of PTS and quality of life of patients.</p><p id="par0170" class="elsevierStylePara elsevierViewall">In short, data from this study reveal very high rates of PTS in patients who had a previous episode of DVT and it affects significantly their health. The risk of developing a PTS appears to be higher in patients with higher number of risk factors for thromboembolism. Prevention from recurrent thrombosis and from its initial form will reduce the risk of long-term complications of venous thrombosis.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest affecting the development of the research, which was funded and sponsored by Bayer Hispania, S. L.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres644384" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec657453" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres644383" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec657452" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methodology" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and methods" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sample size" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis of post-thrombotic syndrome" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Assessment of quality of life" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Population characteristics" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "PTS prevalence" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Risk factors" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Quality of life" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interests" ] 9 => array:2 [ "identificador" => "xack218285" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-19" "fechaAceptado" => "2015-04-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec657453" "palabras" => array:4 [ 0 => "Post-thrombotic syndrome" 1 => "Deep vein thrombosis" 2 => "Prevalence" 3 => "Quality of life" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec657452" "palabras" => array:4 [ 0 => "Síndrome postrombótico" 1 => "Trombosis venosa profunda" 2 => "Prevalencia" 3 => "Calidad de vida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The prevalence of post-thrombotic syndrome (PTS) in Spain is not known accurately at present. The main objective of this study was to determine the prevalence of PTS and the possible prognostic factors related to its development and impact on quality of life.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was an observational, multicenter, cross-sectional and retrospective study of patients who had suffered a deep vein thrombosis (DVT) between March 2010 and March 2011. The Villalta scale was applied as a standardized assessment of PTS at the enrollment visit. According to the score, distribution was: patients with PTS (score<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4) and patients without PTS (score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4). Subsequently, DVT data and risk factors were collected retrospectively. The quality of life of patients was evaluated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In total 511 patients with DVT were enrolled, of which 7 patients were excluded as they did not meet the inclusion/exclusion criteria. The prevalence of PTS was 53%, with 56.2% having a mild character, 20.6% moderate, and 23.2% severe. The presence of risk factors for DVT including immobilization, hormonal therapy and obesity was significantly higher in patients with PTS than in patients without PTS. There were not significant differences in the location of the DVT. The perception of patients about their health was significantly worse in patients with DVT.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of PTS in patients with DVT is very high. The presence of risk factors for DVT clearly contributes to a greater predisposition to suffering PTS in an average time of 2 years.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Actualmente no se conoce con exactitud la prevalencia del síndrome postrombótico (SPT) en España. El objetivo principal de este trabajo fue determinar la prevalencia de SPT y los posibles factores pronóstico asociados a su desarrollo y el impacto sobre la calidad de vida.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, multicéntrico, de corte trasversal y seguimiento retrospectivo. Se incluyeron pacientes que hubieran sufrido una trombosis venosa profunda (TVP) entre marzo de 2010 y marzo de 2011. En la inclusión, el investigador examinó a los pacientes y cumplimentó la escala Villalta; en función de la puntuación, se distribuyeron en pacientes con SPT (puntuación<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4) y pacientes sin SPT (puntuación<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4). Posteriormente, se recogieron de forma retrospectiva datos de la TVP y factores de riesgo. Se evaluó la calidad de vida de los pacientes.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidos 511 pacientes con TVP, de los que se excluyeron 7 por no cumplir algún criterio de inclusión/exclusión. La prevalencia de SPT fue del 53%, siendo un 56,2% de carácter leve, un 20,6%, moderado, y un 23,2%, grave. La presencia de factores de riesgo de TVP, como inmovilización, terapia hormonal y obesidad, fue significativamente mayor en pacientes con SPT frente a pacientes sin SPT. No se encontraron diferencias significativas en la localización de TVP. La percepción del paciente sobre su salud fue significativamente peor en presencia de SPT.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de SPT en pacientes con TVP es muy alta. La presencia de factores de riesgo de TVP contribuye a una mayor predisposición a presentar SPT, en un tiempo medio de 2 años.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Ordi J, Salmerón L, Acosta F, Camacho I, Marín N, en representación de los investigadores del estudio ESPOT-TVP. Estudio de factores pronósticos y de la prevalencia del síndrome postrombótico en España en pacientes con trombosis venosa profunda. Med Clin (Barc). 2016;146:49–54.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The complete list of researchers ESPOT-TVP study is presented in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix</a>.</p>" "identificador" => "fn1" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall">Alberto Rivera Gallego (Complejo Hospitalario de Vigo); José M. García Colodro (H. Lucus Augusti); Elena Fernández (H. Arquitecto Marcide); Pere Carreño Ávila (H. de Mataró); Mariano Valdés Oliveras (H. de Viladecans); Pablo Javier Marchena Yglesias (H. Sant Boi); Pablo Busca (H. Donostia); Miguel Martin Pedrosa (H. Clínico de Valladolid); Angel Flores Herrero (H. Virgen de la Salud); María Teresa Capilla Montes (CHUA Albacete); José M. Pedrajas Navas (H. Clínico San Carlos); Angel Robles Marhuenda (H. La Paz); Carlos González Gómez (H. 12 de Octubre); Manuel Beltrán Robles (H. Virgen del Camino-Sanlúcar); Manuel Arenas Gordillo (H. San Juan de Dios); Juan Bosco López Sáez (H. Puerto Real); Jorge Marín Martin (H. La Merced de Osuna-Sevilla); Raimundo Tirado Miranda (H. Infanta Margarita); Rafael Giménez Domenech (H. Cruz Roja de Córdoba); Jose Moreno Escobar (H. Torrecárdenas); José M. Alonso Pardo (H. Los Arcos del Mar Menor); Ginés Gascón Ramón (H. Comarcal Castellón de la Plana); Oscar Torregrosa Suau (Clínica Mediterránea Neurociencia); Luis Sáez Comet (H. Miguel Servet de Zaragoza); Antonio Salgado y Gabriel Collado (H. Infanta Cristina de Badajoz); Angel Brea Hernando (H. San Pedro de Logroño).</p>" "etiqueta" => "Appendix" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1232 "Ancho" => 1083 "Tamanyo" => 60556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Classification of post-thrombotic syndrome.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1489 "Ancho" => 2475 "Tamanyo" => 201279 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DVT risk factors.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1079 "Ancho" => 1647 "Tamanyo" => 140819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">EuroQol-5D: presence of problems.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SD, standard deviation; NS, not significant; TPS, post-thrombotic syndrome; DVT, deep vein thrombosis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presence of PTS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absence of PTS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Characteristics</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>267 (52.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>237 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age in years (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0018<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sex (male; %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0090<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous diseases (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥3 previous diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Cardiovascular risk factors (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0077<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peripheral vascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">DVT site</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Femoral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Femoral-iliac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Femoral-popliteal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other sites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Clinical symptomatology</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0348<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonary thromboembolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cyanosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0079<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paradoxical embolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1062180.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mann–Whitney <span class="elsevierStyleItalic">U</span> test.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Chi-square test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The post-thrombotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.R. 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